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1、右美托咪啶复合舒芬太尼用于胸科手术后自控静脉镇痛效果观察作者单位：230061安徽医科大学第三附属医院麻醉科通信作者：董春山，Email：dcs0018@163.com【摘要】目的确定右美托咪啶复合舒芬太尼用于胸科手术后自控静脉镇痛（PCIA）的半数有效剂量（ED50）。方法择期在全身麻醉下行开胸手术患者，性别不限，ASA分级I~II级，年龄32~65岁，患者采用静-吸复合全身麻醉。于手术结束时启用术后静脉自控镇痛（PCIA)，使用药物为舒芬太尼2.5μg/kg复合右美托咪啶，第1例患者右美托咪啶复合剂量为
2、3μg/kg，采用改良序贯法的等差级剂量为0.5μg/kg。采用VAS评分、Ramsay镇静评分等综合评价镇痛镇静效果满意度。采用概率单位回归分析法计算镇痛镇静满意的ED50及95%可信区间(CI)。结果入选患者35例，PCIA效果满意17例，效果不满意18例；术后48h内无镇静过度和呼吸抑制不良反应发生。右美托咪啶复合舒芬太尼PCIA效果满意的ED50为3.99μg/kg,95%CI为2.29~4.43μg/kg，相应的ED95为4.92μg/kg,95%CI为4.43~10.50μg/kg。结论右美托咪
3、啶复合舒芬太尼PCIA效果满意的ED50为3.99μg/kg。【关键词】右美托咪啶；舒芬太尼；胸科手术；术后；静脉自控镇痛；剂量效应关系Medianeffectivedoseofdexmedetomidinecombinedwithsufentanilforintravenouspatient-controlledanalgesiainthoracicsurgeryDongChunshan,SunPeng,ZangJun,YuJunma.DepartmentofAnesthesiology,Thirdaff
4、iliatedhospitalofAnhuiMedicalUniversity，Hefei230061,ChinaCorrespondingauthor:DONGChun-shan,Email:dcs0018@163.com【Abstract】ObjectiveTodeterminethemedianeffectivedoseofdexmedetomidinecombinedwithsufentanilforintravenouspatient-controlledanalgesiainthoracicsu
5、rgery.MethodsThirty-fiveASAI-IIpatientsofbothsexes,aged32-65yr,scheduledforthoracicsurgeryundergeneralanesthesiawithintravenouscombinedwithinhalation,wereenrolledinthisstudy.Atendofsurgery,patientswereattachedtoapostoperativeintravenouscontrolledanalgesiam
6、achine,whichwascombinedsufentanil2.5μg/kganddexmedetomidine,thedoseofdexmedetomidinewas8determinedusingthemodifiedup-and-downmethod(0.5μg/kgasastepsize).Thefirstpatientwastestedat3μg/kgdexmedetomidine.Analgesicandsedationefficacywereassessedthroughoutthe48
7、hstudyperiodwith10-cmvisualanalogscalesand6-pointRamsaysedationscales.ProbitanalysiswasusedforcalculatingED50,ED95and95%confidenceinterval(CI).ResultsTheresponsesof35consecutivepatientsinwhomreceivingintravenouspatient-controlledanalgesiawasassessed,and17p
8、atientsweresatisfiedand18patientswerenotsatisfied.Nopatientdevelopedclinicallysignificantrespiratorydepressionorexcessivesedation.TheED50ofdexmedetomidinewas3.99μg/kg(95%CIwas2.29~4.43μg/kg)andED95ofdexmedeto
